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Male circumcision for HIV control

Male circumcision has been performed on boys and young men for many years, primarily for religious and cultural reasons. Studies conducted since the mid-1980s have suggested that circumcised men have a lower prevalence of HIV infection than uncircumcised men, but it was not clear whether promoting circumcision among men who
would not otherwise be circumcised would result in a lower incidence of HIV infection.

Recently, three randomized, controlled trials, in Kenya, South Africa and Uganda, have provided strong evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by up to 60%. In response to these new data, the Department of Reproductive Health and Research (RHR), together with the WHO Department of HIV/AIDS and the Joint United Nations Programme on HIV/AIDS (UNAIDS), launched a number of new initiatives in 2006–2007.

In partnership with other WHO departments, UNAIDS, and the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO), RHR has developed a Manual for male circumcision under local anaesthesia. The manual is intended for use by clinical officers, who can be trained to perform uncomplicated circumcision, and to refer more complex cases. The manual is expected to be published in 2011.

The manual itself is supported by training guides and a certification framework, to facilitate the upgrading of skills of officers who are not otherwise authorized to perform surgery.

RHR is also supporting the development of a toolkit that will allow countries to assess their preparedness for introducing or expanding male circumcision services.

RHR contributed to a number of other documents dealing with various aspects of male circumcision, including a review of global trends and determinants of prevalence, safety and acceptability, and a guide to
enhancing the quality of male circumcision services.